Efforts of hospital system wound care teams to reduce hospital acquired pressure ulcers

New reimbursement policies developed by the Centers for Medicare and Medicaid Services (CMS) are revolutionizing the health care landscape in America. The policies focus on clinical quality and patient outcomes. As part of the new policies, certain hospital acquired conditions have been identified by Medicare as "reasonably preventable". Beginning October 1, 2008, Medicare will no longer reimburse hospitals for these conditions developed after admission, pressure ulcers are among the most common of these conditions.^ In this practice-based culminating experience the objective was to provide a practical account of the process of program development, implementation and evaluation in a public health setting. In order to decrease the incidence of pressure ulcers, the program development team of the hospital system developed a comprehensive pressure ulcer prevention program using a "bundled" approach. The pressure ulcer prevention bundle was based on research supported by the Institute for Healthcare Improvement, and addressed key areas of clinical vulnerability for pressure ulcer development. The bundle consisted of clinical processes, policies, forms, and resources designed to proactively identify patients at risk for pressure ulcer development. Each element of the bundle was evaluated to ensure ease of integration into the workflow of nurses and clinical ancillary staff. Continued monitoring of pressure ulcer incidence rates will provide statistical validation of the impact of the prevention bundle. ^

The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Effects of congressional modernization laws on public access to innovative medical device technologies

The Federal Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS) play key roles in making Class III, medical devices available to the public, and they are required by law to meet statutory deadlines for applications under review. Historically, both agencies have failed to meet their respective statutory requirements. Since these failures affect patient access and may adversely impact public health, Congress has enacted several “modernization” laws. However, the effectiveness of these modernization laws has not been adequately studied or established for Class III medical devices. ^ The aim of this research study was, therefore, to analyze how these modernization laws may have affected public access to medical devices. Two questions were addressed: (1) How have the FDA modernization laws affected the time to approval for medical device premarket approval applications (PMAs)? (2) How has the CMS modernization law affected the time to approval for national coverage decisions (NCDs)? The data for this research study were collected from publicly available databases for the period January 1, 1995, through December 31, 2008. These dates were selected to ensure that a sufficient period of time was captured to measure pre- and post-modernization effects on time to approval. All records containing original PMAs were obtained from the FDA database, and all records containing NCDs were obtained from the CMS database. Source documents, including FDA premarket approval letters and CMS national coverage decision memoranda, were reviewed to obtain additional data not found in the search results. Analyses were conducted to determine the effects of the pre- and post-modernization laws on time to approval. Secondary analyses of FDA subcategories were conducted to uncover any causal factors that might explain differences in time to approval and to compare with the primary trends. The primary analysis showed that the FDA modernization laws of 1997 and 2002 initially reduced PMA time to approval; after the 2002 modernization law, the time to approval began increasing and continued to increase through December 2008. The non-combined, subcategory approval trends were similar to the primary analysis trends. The combined, subcategory analysis showed no clear trends with the exception of non-implantable devices, for which time to approval trended down after 1997. The CMS modernization law of 2003 reduced NCD time to approval, a trend that continued through December 2008. This study also showed that approximately 86% of PMA devices do not receive NCDs. ^ As a result of this research study, recommendations are offered to help resolve statutory non-compliance and access issues, as follows: (1) Authorities should examine underlying causal factors for the observed trends; (2) Process improvements should be made to better coordinate FDA and CMS activities to include sharing data, reducing duplication, and establishing clear criteria for “safe and effective” and “reasonable and necessary”; (3) A common identifier should be established to allow tracking and trending of applications between FDA and CMS databases; (4) Statutory requirements may need to be revised; and (5) An investigation should be undertaken to determine why NCDs are not issued for the majority of PMAs. Any process improvements should be made without creating additional safety risks and adversely impacting public health. Finally, additional studies are needed to fully characterize and better understand the trends identified in this research study.^

Inappropriate imaging utilization in Texas: Geographic variation and predictive factors

Objective::Describe and understand regional differences and associated multilevel factors (patient, provider and regional) to inappropriate utilization of advance imaging tests in the privately insured population of Texas. Methods: We analyzed Blue Cross Blue Shield of Texas claims dataset to study the advance imaging utilization during 2008-2010 in the PPO/PPO+ plans. We used three of CMS "Hospital Outpatient Quality Reporting" imaging efficiency measures. These included ordering MRI for low back pain without prior conservative management (OP-8) and utilization of combined with and without contrast abdominal CT (OP-10) and thorax CT (OP-11). Means and variation by hospital referral regions (HRR) in Texas were measured and a multilevel logistic regression for being a provider with high values for any the three OP measures was used in the analysis. We also analyzed OP-8 at the individual level. A multilevel logistic regression was used to identify predictive factors for having an inappropriate MRI for low back pain. Results: Mean OP-8 for Texas providers was 37.89%, OP-10 was 29.94% and OP-11 was 9.24%. Variation was higher for CT measure. And certain HRRs were consistently above the mean. Hospital providers had higher odds of high OP-8 values (OP-8: OR, 1.34; CI, 1.12-1.60) but had smaller odds of having high OP-10 and OP-11 values (OP-10: OR, 0.15; CI, 0.12-0.18; OP-11: OR, 0.43; CI, 0.34-0.53). Providers with the highest volume of imaging studies performed, were less likely to have high OP-8 measures (OP-8: OR, 0.58; CI, 0.48-0.70) but more likely to perform combined thoracic CT scans (OP-11: OR, 1.62; CI, 1.34-1.95). Males had higher odds of inappropriate MRI (OR, 1.21; CI, 1.16-1.26). Pattern of care in the six months prior to the MRI event was significantly associated with having an inappropriate MRI. Conclusion::We identified a significant variation in advance imaging utilization across Texas. Type of facility was associated with measure performance, but the associations differ according to the type of study. Last, certain individual characteristics such as gender, age and pattern of care were found to be predictors of inappropriate MRIs.^

Efectos de un programa de flexibilidad en el desarrollo de la fuerza muscular en jugadoras de fútbol femenil

Se analizó el impacto de un programa de entrenamiento de flexibilidad sobre el desarrollo de la fuerza muscular en 16 jugadores de futbol con edad de 19.032.7 años. Se entrenó durante 30 días y 5 veces por semanas, donde el grupo "A" realizó entrenamiento de flexibilidad, mientras que "B" el entrenamiento regular. Se midió la flexibilidad, 1RM, salto vertical, peso, talla, circunferencia de pantorrilla y muslo. Los resultados muestran valores para A y B respectivamente, donde el IGF fue de 91.01 18.3 y 111.93 23.5; 78.22 29, y 79.03 29.1. La circunferencia femoral, 48.04 3.6 cms y 49.54 3.4 cms.; 47.56 4.9 y 47.89 5.2. Circunferencia de pantorrilla, 33.83 2.7 cm y 35.21 2.4 cm; 33.83 2 y 33.73 2.8. Fuerza 48.13 7.8 Kg. y 53.38 8.2 Kg.; 52.63 8.6 Kg. y 53.39 9.1 Kg. Potencia anaeróbica, 34.13 2.9 cm. y 36.63 1.7 cm; 38.25 4.7 y 37.06 3.4. Como conclusión se tiene que el uso la flexibilidad impacta de forma positiva en el IGF y por tanto en el desarrollo favorable muscular de jugadoras de fútbol.

Efectos de un programa de flexibilidad en el desarrollo de la fuerza muscular en jugadoras de fútbol femenil

Se analizó el impacto de un programa de entrenamiento de flexibilidad sobre el desarrollo de la fuerza muscular en 16 jugadores de futbol con edad de 19.032.7 años. Se entrenó durante 30 días y 5 veces por semanas, donde el grupo "A" realizó entrenamiento de flexibilidad, mientras que "B" el entrenamiento regular. Se midió la flexibilidad, 1RM, salto vertical, peso, talla, circunferencia de pantorrilla y muslo. Los resultados muestran valores para A y B respectivamente, donde el IGF fue de 91.01 18.3 y 111.93 23.5; 78.22 29, y 79.03 29.1. La circunferencia femoral, 48.04 3.6 cms y 49.54 3.4 cms.; 47.56 4.9 y 47.89 5.2. Circunferencia de pantorrilla, 33.83 2.7 cm y 35.21 2.4 cm; 33.83 2 y 33.73 2.8. Fuerza 48.13 7.8 Kg. y 53.38 8.2 Kg.; 52.63 8.6 Kg. y 53.39 9.1 Kg. Potencia anaeróbica, 34.13 2.9 cm. y 36.63 1.7 cm; 38.25 4.7 y 37.06 3.4. Como conclusión se tiene que el uso la flexibilidad impacta de forma positiva en el IGF y por tanto en el desarrollo favorable muscular de jugadoras de fútbol.

Efectos de un programa de flexibilidad en el desarrollo de la fuerza muscular en jugadoras de fútbol femenil

Se analizó el impacto de un programa de entrenamiento de flexibilidad sobre el desarrollo de la fuerza muscular en 16 jugadores de futbol con edad de 19.032.7 años. Se entrenó durante 30 días y 5 veces por semanas, donde el grupo "A" realizó entrenamiento de flexibilidad, mientras que "B" el entrenamiento regular. Se midió la flexibilidad, 1RM, salto vertical, peso, talla, circunferencia de pantorrilla y muslo. Los resultados muestran valores para A y B respectivamente, donde el IGF fue de 91.01 18.3 y 111.93 23.5; 78.22 29, y 79.03 29.1. La circunferencia femoral, 48.04 3.6 cms y 49.54 3.4 cms.; 47.56 4.9 y 47.89 5.2. Circunferencia de pantorrilla, 33.83 2.7 cm y 35.21 2.4 cm; 33.83 2 y 33.73 2.8. Fuerza 48.13 7.8 Kg. y 53.38 8.2 Kg.; 52.63 8.6 Kg. y 53.39 9.1 Kg. Potencia anaeróbica, 34.13 2.9 cm. y 36.63 1.7 cm; 38.25 4.7 y 37.06 3.4. Como conclusión se tiene que el uso la flexibilidad impacta de forma positiva en el IGF y por tanto en el desarrollo favorable muscular de jugadoras de fútbol.

Steps Ahead in the Few-Group CRoss-Section Library Generation at the Pin Level

There exists an interest in performing pin-by-pin calculations coupled with thermal hydraulics so as to improve the accuracy of nuclear reactor analysis. In the framework of the EU NURISP project, INRNE and UPM have generated an experimental version of a few group diffusion cross sections library with discontinuity factors intended for VVER analysis at the pin level with the COBAYA3 code. The transport code APOLLO2 was used to perform the branching calculations. As a first proof of principle the library was created for fresh fuel and covers almost the full parameter space of steady state and transient conditions. The main objective is to test the calculation schemes and post-processing procedures, including multi-pin branching calculations. Two library options are being studied: one based on linear table interpolation and another one using a functional fitting of the cross sections. The libraries generated with APOLLO2 have been tested with the pin-by-pin diffusion model in COBAYA3 including discontinuity factors; first comparing 2D results against the APOLLO2 reference solutions and afterwards using the libraries to compute a 3D assembly problem coupled with a simplified thermal-hydraulic model.

¿Qué Método Utilizar Para Estimar la Temperatura estática de una formación de Petróleo?

Conocer la temperatura estática de una formación de petróleo es importante a la hora de evaluar y terminar un pozo. Existe una gran variedad de métodos para la determinación de esta temperatura. Cada método utiliza hipótesis y simplificaciones distintas que llevan a estimaciones diferentes, en algunos casos bastante alejadas del valor real. Esto hace difícil saber qué método utilizar. En este trabajo, se aplican los métodos de cálculo más comunes - Horner (HM), flujo radial y esférico (SRM), de las dos medidas (TLM) y de fuente de calor cilíndrica (CSM)- a cuatro pozos distintos. Se describe cómo aplicarlos en casos reales. Se presta especial atención a establecer los datos necesarios en cada caso: propiedades termo-físicas y número de medidas, y se proporcionan criterios para estimarlos en caso de no conocer su valor real. Como conclusiones a este trabajo se presentan una serie de pautas que permiten seleccionar el método de cálculo más conveniente en función de la información de que se disponga

Sociedades de seguros de incendios en la aplicación de la normativa de prevención de incendios (2ª PARTE)

Una vez analizada la creación de las primeras sociedades de seguros, en esta segunda parte del artículo se habla sobre los efectos de esas sociedades así como su colaboración con los servicios de extinción de incendios y las primeras instalaciones de protección frente a incendios

Intermittency reinjection probability density function with and without noise effects.

Intermittency phenomenon is a continuous route from regular to chaotic behaviour. Intermittency is an occurrence of a signal that alternates chaotic bursts between quasi-regular periods called laminar phases, driven by the so called reinjection probability density function (RPD). In this paper is introduced a new technique to obtain the RPD for type-II and III intermittency. The new RPD is more general than the classical one and includes the classical RPD as a particular case. The probabilities of the laminar length, the average laminar lengths and the characteristic relations are determined with and without lower bound of the reinjection in agreement with numerical simulations. Finally, it is analyzed the noise effect in intermittency. A method to obtain the noisy RPD is developed extending the procedure used in the noiseless case. The analytical results show a good agreement with numerical simulations.

Business Process Optimization in Madrid City Council.

While designing systems and products requires a deep understanding of influences that achieve desirable performance, the need for an efficient and systematic decision-making approach drives the need for optimization strategies. This paper provides the motivation for this topic as well as a description of applications in Computing Center of Madrid city Council. Optimization applications can be found in almost all areas of engineering. Typical problems in process, working with a database, arise in query design, entity model design and concurrent processes. This paper proposes a solution to optimize a night process dealing with millions of records with an overall performance of about eight times in computation time.

Desarrollo de un sitio web con conexión con redes sociales

La Asociación Española de Lucha contra la Esclerosis múltiple (AELEM) tiene un sitio web un poco anticuado, con información mal distribuida y acumulada toda en la sección de inicio, por lo tanto querían renovar su sitio web y conseguir otro que fuera mucho más intuitivo, que estuviera bien distribuido y que fuera más sencillo de usar para nuevos usuarios. En este contexto, el objetivo de este trabajo es desarrollar un sitio web que cumpla los nuevos requisitos de los miembros de la asociación, así como que sea más fácil para ellos mismo de administrar. Para ello a través del uso de un CMS se desarrolló un nuevo sitio web para AELEM, con nuevas funcionalidades y con las ventajas de Joomla, un CMS que pueden administrar. A través del desarrollo de diferentes componentes y módulos se consiguieron satisfacer las necesidades de los miembros de la asociación, así como se fueron añadiendo las nuevas funcionalidades que iban pidiendo a lo largo del proyecto. Los resultados obtenidos han sido muy positivos, a la junta directiva y a los miembros seleccionados de la asociación para evaluar el sitio web les ha gustado tanto la estética como la nueva distribución de la información o las nuevas funcionalidades incluidas en el sitio web, y la asociación utilizará el nuevo sitio web que se le ha desarrollado, y además con las clases que se les ha ido impartiendo podrán administrarla. ---ABSTRACT---The Spanish association of fight against the multiple sclerosis (La Asociación Española de Lucha contra la Esclerosis Multiple “AELEM”) has a fairly old fashioned website, with information poorly distributed and all accumulated in the home section. This is the reason why the association has chosen to renew its website and make a more intuitive one, with better distributed information and easier to navigate for new users. In this context, the objective of this project is to develop a new website that meets the new requirements of the association. In addition, they want a website which is easier to administrate. To archive these objectives we used a CMS to develop a new website for AELEM, with new functionalities and with the advantages of Joomla, a CMS that they can administrate. Different components and modules were developed in order to satisfy the needs of the association members and new functionalities were added as required throughout the entire project. The results we have obtained were very positive. The board of directors and the members of the association that were chosen to test the website have liked the appearance, the new distribution of the information as well as the new functionalities of the website. The association will use the new website we have developed and with the classes we have given them, they will be able to administrate it.

Dynamic analysis of payloads and structures with intermediate modal density

La necesidad de desarrollar técnicas para predecir la respuesta vibroacústica de estructuras espaciales lia ido ganando importancia en los últimos años. Las técnicas numéricas existentes en la actualidad son capaces de predecir de forma fiable el comportamiento vibroacústico de sistemas con altas o bajas densidades modales. Sin embargo, ambos rangos no siempre solapan lo que hace que sea necesario el desarrollo de métodos específicos para este rango, conocido como densidad modal media. Es en este rango, conocido también como media frecuencia, donde se centra la presente Tesis doctoral, debido a la carencia de métodos específicos para el cálculo de la respuesta vibroacústica. Para las estructuras estudiadas en este trabajo, los mencionados rangos de baja y alta densidad modal se corresponden, en general, con los rangos de baja y alta frecuencia, respectivamente. Los métodos numéricos que permiten obtener la respuesta vibroacústica para estos rangos de frecuencia están bien especificados. Para el rango de baja frecuencia se emplean técnicas deterministas, como el método de los Elementos Finitos, mientras que, para el rango de alta frecuencia las técnicas estadísticas son más utilizadas, como el Análisis Estadístico de la Energía. En el rango de medias frecuencias ninguno de estos métodos numéricos puede ser usado con suficiente precisión y, como consecuencia -a falta de propuestas más específicas- se han desarrollado métodos híbridos que combinan el uso de métodos de baja y alta frecuencia, intentando que cada uno supla las deficiencias del otro en este rango medio. Este trabajo propone dos soluciones diferentes para resolver el problema de la media frecuencia. El primero de ellos, denominado SHFL (del inglés Subsystem based High Frequency Limit procedure), propone un procedimiento multihíbrido en el cuál cada subestructura del sistema completo se modela empleando una técnica numérica diferente, dependiendo del rango de frecuencias de estudio. Con este propósito se introduce el concepto de límite de alta frecuencia de una subestructura, que marca el límite a partir del cual dicha subestructura tiene una densidad modal lo suficientemente alta como para ser modelada utilizando Análisis Estadístico de la Energía. Si la frecuencia de análisis es menor que el límite de alta frecuencia de la subestructura, ésta se modela utilizando Elementos Finitos. Mediante este método, el rango de media frecuencia se puede definir de una forma precisa, estando comprendido entre el menor y el mayor de los límites de alta frecuencia de las subestructuras que componen el sistema completo. Los resultados obtenidos mediante la aplicación de este método evidencian una mejora en la continuidad de la respuesta vibroacústica, mostrando una transición suave entre los rangos de baja y alta frecuencia. El segundo método propuesto se denomina HS-CMS (del inglés Hybrid Substructuring method based on Component Mode Synthesis). Este método se basa en la clasificación de la base modal de las subestructuras en conjuntos de modos globales (que afectan a todo o a varias partes del sistema) o locales (que afectan a una única subestructura), utilizando un método de Síntesis Modal de Componentes. De este modo es posible situar espacialmente los modos del sistema completo y estudiar el comportamiento del mismo desde el punto de vista de las subestructuras. De nuevo se emplea el concepto de límite de alta frecuencia de una subestructura para realizar la clasificación global/local de los modos en la misma. Mediante dicha clasificación se derivan las ecuaciones globales del movimiento, gobernadas por los modos globales, y en las que la influencia del conjunto de modos locales se introduce mediante modificaciones en las mismas (en su matriz dinámica de rigidez y en el vector de fuerzas). Las ecuaciones locales se resuelven empleando Análisis Estadístico de Energías. Sin embargo, este último será un modelo híbrido, en el cual se introduce la potencia adicional aportada por la presencia de los modos globales. El método ha sido probado para el cálculo de la respuesta de estructuras sometidas tanto a cargas estructurales como acústicas. Ambos métodos han sido probados inicialmente en estructuras sencillas para establecer las bases e hipótesis de aplicación. Posteriormente, se han aplicado a estructuras espaciales, como satélites y reflectores de antenas, mostrando buenos resultados, como se concluye de la comparación de las simulaciones y los datos experimentales medidos en ensayos, tanto estructurales como acústicos. Este trabajo abre un amplio campo de investigación a partir del cual es posible obtener metodologías precisas y eficientes para reproducir el comportamiento vibroacústico de sistemas en el rango de la media frecuencia. ABSTRACT Over the last years an increasing need of novel prediction techniques for vibroacoustic analysis of space structures has arisen. Current numerical techniques arc able to predict with enough accuracy the vibro-acoustic behaviour of systems with low and high modal densities. However, space structures are, in general, very complex and they present a range of frequencies in which a mixed behaviour exist. In such cases, the full system is composed of some sub-structures which has low modal density, while others present high modal density. This frequency range is known as the mid-frequency range and to develop methods for accurately describe the vibro-acoustic response in this frequency range is the scope of this dissertation. For the structures under study, the aforementioned low and high modal densities correspond with the low and high frequency ranges, respectively. For the low frequency range, deterministic techniques as the Finite Element Method (FEM) are used while, for the high frequency range statistical techniques, as the Statistical Energy Analysis (SEA), arc considered as more appropriate. In the mid-frequency range, where a mixed vibro-acoustic behaviour is expected, any of these numerical method can not be used with enough confidence level. As a consequence, it is usual to obtain an undetermined gap between low and high frequencies in the vibro-acoustic response function. This dissertation proposes two different solutions to the mid-frequency range problem. The first one, named as The Subsystem based High Frequency Limit (SHFL) procedure, proposes a multi-hybrid procedure in which each sub-structure of the full system is modelled with the appropriate modelling technique, depending on the frequency of study. With this purpose, the concept of high frequency limit of a sub-structure is introduced, marking out the limit above which a substructure has enough modal density to be modelled by SEA. For a certain analysis frequency, if it is lower than the high frequency limit of the sub-structure, the sub-structure is modelled through FEM and, if the frequency of analysis is higher than the high frequency limit, the sub-structure is modelled by SEA. The procedure leads to a number of hybrid models required to cover the medium frequency range, which is defined as the frequency range between the lowest substructure high frequency limit and the highest one. Using this procedure, the mid-frequency range can be define specifically so that, as a consequence, an improvement in the continuity of the vibro-acoustic response function is achieved, closing the undetermined gap between the low and high frequency ranges. The second proposed mid-frequency solution is the Hybrid Sub-structuring method based on Component Mode Synthesis (HS-CMS). The method adopts a partition scheme based on classifying the system modal basis into global and local sets of modes. This classification is performed by using a Component Mode Synthesis, in particular a Craig-Bampton transformation, in order to express the system modal base into the modal bases associated with each sub-structure. Then, each sub-structure modal base is classified into global and local set, fist ones associated with the long wavelength motion and second ones with the short wavelength motion. The high frequency limit of each sub-structure is used as frequency frontier between both sets of modes. From this classification, the equations of motion associated with global modes are derived, which include the interaction of local modes by means of corrections in the dynamic stiffness matrix and the force vector of the global problem. The local equations of motion are solved through SEA, where again interactions with global modes arc included through the inclusion of an additional input power into the SEA model. The method has been tested for the calculation of the response function of structures subjected to structural and acoustic loads. Both methods have been firstly tested in simple structures to establish their basis and main characteristics. Methods are also verified in space structures, as satellites and antenna reflectors, providing good results as it is concluded from the comparison with experimental results obtained in both, acoustic and structural load tests. This dissertation opens a wide field of research through which further studies could be performed to obtain efficient and accurate methodologies to appropriately reproduce the vibro-acoustic behaviour of complex systems in the mid-frequency range.